Organization · Type 2 NPI
Idaho Innovative Dentistry, PLLC
Dental Clinic/Center · Eagle, ID
NPI number
1649620139
Active
Practice location
467 S Rivershore Ln
Eagle, ID 83616-4978
Mailing address
467 S. Rivershore Lane
Eagle, ID 83616
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dental Clinic/Center Primary | 261QD0000X | D-4002 (ID) |
Dental Clinic/Center: Definition to come...
2 other providers at this address
Other dental clinic/center providers in Eagle
About NPI 1649620139
Idaho Innovative Dentistry, PLLC's National Provider Identifier is 1649620139, issued on Jun 15, 2016. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Eagle, ID. The record was last updated on Jun 15, 2016.